Conservative treatment for disc disease (IVDD)

Brief summary of what happened

The swollen, herniated disc puts pressure on the spinal cord and other nerve fibers in the area. This is painful and the pressure on the spinal cord prevents nerve impulses from passing between the brain and the rear part of the body. The animal may be unable to walk or control its colon or bladder. Severe damage to the spinal cord can lead to total paralysis. Quoted from Drs. Foster & Smith Pet Education

How owners can help

Healing happens on four levels during Conservative Treatment. Owners can be instrumental in achieving the goals of success in the first three areas for their dog. We humans, however cannot control nerve healing, the body does most of the healing work itself on its own time schedule and to the extent possible. True success with IVDD is measured by the most important goal of returning your dog to a pain free, happy and full-of-love quality of life after crate rest. Dogs do not view loss of ability to walk as a minus as humans do should paralysis occur. Dogs adjust to what is and then get on with the business of fully enjoying all that life has to offer until nerves repair!

What to expect at each level of healing

1. PAIN control happens in a matter of hours with the correct pain medications. The anti-inflammatory works on swelling, pain reliever(s) provide comfort until the inflammation is gone and a stomach protector reduces extra acids anti-inflammatories produce. Typical medications used with IVDD. Signs of pain include yelping, arched back, reluctance to move, tight/tense stomach, trembling or shaking. With a painful disc in the neck, the head will be held in an unsual position such holding head down or nose up high.

2. SWELLING of the spinal cord reduces with the necessary use of big gun medications rather than herbs. Glucocorticoids are synthetic versions of the body’s naturally occurring steroid, cortisol. Steroids are basically the most powerful of anti-inflammatories. With IVDD an anti-inflammatory dose is used, rather than a higher immuno-suppressive dose used in other diseases. There are no safe medications. There are two safety factors with drugs. One is a vet who practices safe medicine with a blood test to verify liver and kidneys are healthy. The other is an owner who is educated on what the side effects are and monitors their dog.

With mild symptoms of pain and no neurological deficits, some vets will choose a NSAID. NSAIDs also are potent drugs calling for owners to be self-educated about the side effects and a vet who checks the health of kidney and liver before prescribing.

When using either a steroid or NSAID, stomach protection such as Pepcid AC is necessary. Dodgerslist follows those vets who are proactive in protecting the stomach, choosing not to wait until a bleeding ulcer or life threatening stomach perforation happens. NOTE: FDA and manufacturer package inserts warn against use of a NSAID with a steroid or with another NSAID without a washout of days before starting the new medication. Vets that practice safe medicine look for a 4-7 day washout out period.

For some dogs, swelling is resolved in two weeks while others take more like a month on an anti-inflammatory. The tapering off of a steroid is a health necessity that also allows a peek into the status of swelling. If pain returns, your vet needs to know and likely more time on the steroid would be prescribed. No signs of pain means the steroid has done the job. NSAIDs do not require tapering off, but require the same observations of pain returning and contacting the vet promptly to extend use.

Monitoring neurological function As damage to the spinal cord increases, there is a predictable path of deterioration. When nerve healing begins, often it follows the reverse order.       • Pain caused by the tearing disc and the resulting inflammation in the spinal cord • Wobbly walking, legs cross • Nails scuffing floor • Paws knuckle • Legs do not work (paralysis, dog is down) • Bladder control is lost • Tail wagging with joy is lost • Deep pain sensation, the last neurological function, a critical indicator for successful surgery. Making Sense of the Neuro Exam

3.DAMAGED DISCS take about 8 weeks to heal and form secure scar tissue. There are no medications that help this along—only time and limited movement of the back and neck which is the purpose of crate rest. When a dog walks and moves the vertebrae move, tearing down the important scar tissue that is forming to stabilize the disc rupture. Anytime out of the crate is a dangerous time for a healing disc. Only potty time and vet appointments are a necessity to be out of the crate. Be diligent about crate rest, cheating on crate rest promotes damage to the disc: no chiropractic therapy, no couches, no sleeping with you, no baths or water therapy during the 8 weeks of crate rest.

With this CT scan made by Dr. Wong, DVM ACVIM, you can visualize how easily movement of walking will cause the vertebrae to push on the damaged disc prolonging healing and pain. Click image to enlarge.

Anytime out of the crate is a dangerous time for the spinal cord. At potty time care is taken to carry the dog to and from the potty place. A sling keeps the rear from tipping and the spine aligned. Either a fence or harness/leash limits footsteps to the very fewest

4. REGAINING NEUROLOGICAL FUNCTIONS are as individual as each injury is different and each dog’s ability to heal is different. There is no time limit for nerves to heal. If deep pain perception is present, even in paralyzed limbs, there is a chance to recover to the point of being able to walk unassisted. Thousands of dogs on Dodgerslist have regained functions in as little as 2 weeks, others 11 months and still others 3 years later. IVDD is a disease of patience to allow the body to heal on its own terms. Acupuncture and Laser Therapy stimulate the cell’s metabolism that leads to the body’s natural repair abilities and can be started at any time.

Future expectations

When surgery is a consideration

	•	If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency and mix of pain relievers) yet the pain can’t be brought under control
	•	STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns
	•	With STRICT crate rest, neurological functions (legs and bladder control) worsen or are lost

After a dog is paralyzed the existence of deep pain sensation is an indicator that surgery could STILL be successful. That window of time is 12-24 hours from losing deep pain sensation (DPS). Even after that window of time time surgery is often successful. The spinal cord is very fragile, the more hours after the window, the less chance of a complete recovery. These photographs from UC Davis are useful in understanding how the herninated disc causes damage to the spinal cord.

No or low interest credit for veterinary costs can be obtained from Care Credit. You find out online if you qualify:

Surgery on the spinal cord takes a well-trained surgeon for this most delicate and tricky of surgeries. Board-certified neuro (ACVIM) and ortho (ACVS) surgical specialists can be found at university vet teaching hospitals and in private hospitals.

Board Certified Dr. Wong, DVM, ACVIM neurology, uses microscope-aided surgery to skillfully remove the offending disc material away from the spinal cord in this video clip.